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Any form of Brexit will negatively impact the NHS, but leaving without a deal is the worst possible scenario, concludes the Health Policy Review. Anna Tobin reports

The Health Policy review co-authored by Professor Tamara Hervey from the University of Sheffield’s School of Law and published in The Lancet today, reports that Brexit will cause negative effects on the healthcare workforce, NHS financing, medical research and availability of medication and vaccines and that the prospect of a no-deal Brexit is the worst possible scenario.

The proposed Withdrawal Agreement is less damaging to the NHS, but the paper highlights serious concerns about the negative impact of Brexit on the NHS beyond the proposed transition period, when the Backstop or arrangements envisaged in the Political Declaration on the Future Relationship would come into force.

It states that under either the Backstop or Political Declaration scenarios, the impact of Brexit on the NHS is only slightly less harmful than the no-deal scenario, though the exact impacts vary.

The report’s authors, all leading experts in public health and law, use the available legal and political texts on four Brexit scenarios to assess the likely impact on fifteen specific aspects of the UK health service. The four scenarios are a no-deal Brexit; the Withdrawal Agreement including a transition agreement until the end of 2020; the Northern Ireland Protocol’s Backstop; and the Political Declaration on the Future Relationship between the UK and EU, which are possible scenarios after the end of the transition period. The authors state that there is little evidence to show that the UK is prepared for any of the eventualities set out in their analysis.

“It’s critical to be clear about the practical effects of disentangling over 40 years of legal integration. This is not something that can be done hastily without potentially jeopardising people’s health,” warned Professor Tamara Hervey. “Future legal relations will have quite different effects on the NHS: these should be taken into account when the UK Government, advised by Parliament, makes its post-Brexit choices.”

Professor Martin McKee, co-author from the London School of Hygiene and Tropical Medicine, added: “Some people will dismiss our analysis as ‘Project Fear’. But with just over a month to go to Brexit, we need to move beyond slogans. We have set out the problems in detail, based on the best available evidence. If others disagree, then they owe it to the British people to say why. It just isn’t good enough to keep saying that ‘something will work out’ without any details of exactly how.”

The study points out that the Withdrawal Agreement provides reciprocal arrangements and mutual recognition of professional qualifications up to 2020, however, no provisions for health care workers have been made in the Backstop or Political Declaration. In the case of a no-deal Brexit, it argues that the Immigration White Paper, which proposes a minimum salary threshold of £30,000 per year, could seriously limit immigration of many health workers to the UK.

The analysis also states that access to capital financing for NHS infrastructure via the European Investment Bank would be negatively impacted in all scenarios and that any form of Brexit will harm the UK’s European and global leadership role in health.

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